Patient care workflow in an Emergency Department (ED) is a unique and demanding environment that has been aided by the advent of Emergency Department Information Systems (EDIS). EDIS are computerized systems that may include functionality intended to assist in the documentation of patient care and management of workflow in an ED. The core features in most EDIS include nursing and physician documentation or Electronic Medical Records (EMRs), a Patient Management Tracking Board, Computerized Provider Order Entry (CPOE), Discharge Instructions, Electronic Prescription Writing, and Department Workflow Reporting.
However, prior EDIS systems have resulted in an industry average 20-30% increase in the time required for clinicians to provide patient care where they are installed. This creates inefficiency and safety risks for both the patient and clinician in the Emergency Department. The traditional core design of such EDIS systems' functionality and how individual patient records are accessed by the user within these systems may create workflow problems for clinicians in the ED.
Such problems may result from the employment of EDIS systems designed primarily from physicians' office, clinic and hospital inpatient environments. However, emergency medicine is a field unlike any other specialty in medicine today where the work environment is starkly unique from the physician's office, clinic, or hospital inpatient workflows. In these latter environments there is commonly a linear patient care workflow that starts with a registration clerk, then the nurse sees the patient, a physician consults with the patient, orders are given and carried out, test results are reviewed, and home-going instructions and prescriptions are rendered to the patient.
While the core approach to medical treatment in the physicians' office is similar to emergency medicine, the workflow by which such treatment is carried out is quite different. The average ED physician spends approximately ⅔ of their time managing more than three patients simultaneously while the average office-based physician may spend less than one minute per hour managing multiple patients (See Ann. Emerg. Med. 2001; 38920:146). An additional study showed that while managing multiple patients, ED physicians are interrupted and have to change their workflow an average of 10.2 times per hour while office-based physicians are interrupted only 3.9 times per hour (See Acad. Emerg. Med. 2000, 7(11): 1239) and 18.5% of the time the physician never returns to the original task (See Qual. and Saf. in Health Care 2010; 039255:1136).
Two distinct traditional design formats have been employed as foundations for developing an EDIS. The first is converting an EMR system designed generally for a physicians' office environment to function in the ED. The second is by using components or modules existing within an existing Hospital Information System (HIS), (e.g. the main Hospital patient management system), and combining them together to meet the required functionality demands of the ED.
Prior EDIS designs may center on a tracking board as a user homepage. All actions are initiated and centered on this screen, including managing the patients the user is responsible for and entering and exiting physician and nursing patient records. For HIS and physicians' office-based systems, this means entering and exiting multiple modules from the tracking board or opening and closing a chart from the tracking board each time a user needs to work on a new patient record.
As shown in FIG. 1, an EDIS system designed for a physicians' office environment may use a linear patient encounter as the core workflow design and require the user to perform multiple mouse clicks to return to a home page from a patient record in order to navigate to another patient. Multiple clicks are then required to open a new patient record, locate a section (e.g. physician or nurse chart), and then locate the desired specific information within that chart. This creates a state of continuous mouse clicking and/or scrolling for the user in order to migrate in and out of various patient records. This design functionality is seldom an issue in the office environment as this workflow is rarely interrupted, time is not as critical, and rarely is there more than one patient in the process at a time. However, repeating this process for navigating between each patient or accounting for each interruption during the period of a workday in the ED may become an exceedingly inefficient, frustrating, and unacceptable process for most physicians and nurses.
As shown in FIG. 2, a Hospital Information System (HIS)-based EDIS design may utilize available pre-existing “modules” within an HIS such as Nursing Documentation and CPOE from an Inpatient Health Record, Physician Documentation from an Ambulatory component, a Tracking Board from a Surgical component, and so on. These modules may then be combined together to form an EDIS. The workflow resulting from this design requires the user to enter and leave a separate module for each step in the care process and then locate the desired patient within the module each time they enter and leave the module.
The outcome is a fragmented patient record and a process necessitating multiple user inputs to move in and out of separate modules for every step in patient care requiring significant additional time as opposed to having a single “patient record” interface that contains all of the required functionality elements for that patient's care. For example, placing orders for a patient, documenting the physician history and reviewing lab results are all steps that would require multiple user inputs to enter and leave multiple modules, finding the patient within each module, and carrying out the desired task.
Additionally, most EDs have multiple users, including physicians and nurses, working simultaneously to care for a single patient. HIS and physicians' office-based EDIS design often allow only one user to modify a patient record at a time. Also, traditional EDIS Tracking Boards may show all of the patients currently in an ED and all of the users assigned to them at once on one home screen. In the case of an ED, there may be up to 75 or more patients visible at once on a large ED Tracking Board. Physicians and nurses may be assigned to 1-10 patients or more and migrating from one patient record to another, or even simply locating the patients the user is responsible for, frequently requires sorting through all of the other patients on the Tracking Board. This creates unnecessary and time consuming confusion or “noise” for the user in a busy work environment.
Further, EDIS systems may also require the user to electronically sign patient records at the end of an encounter and then “Lock” the record which converts it to a non-modifiable format that can be transferred to the record storage department for processing, billing, and storage. Failure of the user to complete these steps results in the patient record not being available for electronic storage or further processing with obvious workflow and financial ramifications. The ability for the user to remember these workflow steps and to carry them out in an organized and efficient fashion within the EDIS may present a challenge in the busy ED environment. For example, such activities may frequently have to be carried out after a work shift requiring the user to spend extra time in the system completing the process.
As such it may be desirable to provide an EDIS that includes functionality serving to overcome the above referenced traditional EDIS workflow design inefficiencies and patient safety issues to improve patient care times and create a safer environment for the clinician and patient without having to rely on the need for time-consuming traditional documentation methods (e.g. as dictation or paper templates.)